CA2-ITE Flashcards
(157 cards)
1
Q
Acupuncture can be reversed by _______
A
Naloxone (who knew?)
2
Q
What are three ventilatory goals in Congenital Diaphragmatic Hernia?
A
- SpO2 90-95%
- Permissive hypercapnea (up to 65 mmHg)
- Low volumes with PIP < 25 cm H20
“Gentle ventilation”
3
Q
Which position change causes the largest decrease in FRC?
A
60 degrees upright to supine. Or supine to Trendelenburg greater than -30 degrees.
4
Q
Name two difference between BLS and PALS
A
- In an unwitnessed collapse on an adult one can leave to activate emergency response, in a child 2 mins CPR should be inititated
- With two providers a ration of 15:2 is used in children
5
Q
What three physiologic conditions are associated with persistent fetal circulation?
A
- Acidosis
- Hypothermia
- Hypoxemia
6
Q
Why is pregnancy a hyper coagulable state?
A
Increase in factors with decrease in factor S and resistance to factor C
7
Q
Inhaled agents and EEG. What’s the relationship?
A
Inhaled agents can cause burst suppression at > 2 MAC doses
8
Q
What is Propofol’s effect on ICP?
A
Decreases by decreasing CMO2
9
Q
What is the drug of choice for any (of the three) Protamine reactions?
A
Epinephrine
10
Q
Early decelerations:
Late decelerations:
Variable decelerations:
A
Early: Head compression
Late: Fetal hypoxia
Variable: Cord compression
11
Q
What is concern for Midazolam infusion in patient with renal failure?
A
Accumulation of metabolite
12
Q
What reflects the least amount of Beam rays during US?
A
Blood (liquid)
13
Q
What is different about coronary perfusion between left and right coronaries?
A
Right is also perfused during systole
14
Q
Define context-senstiive half-time
A
Time required for drug concentration to decrease by one half
15
Q
CSF lavage is a reasonable treatment option for what?
A
High spinal in setting of inadvertent intrathecal catheter placement
16
Q
Large quantities of blood product can lead to what acid base status? 2/2 what?
A
Metabolic alkalosis 2/2 Sodium Citrate
17
Q
What two opioids have the lowest risk of Opioid Induced Neurotoxicity?
A
Fentanyl and Methadone
18
Q
What is the Bohr Effect?
A
The shift in the oxygen dissociation curve caused by changes in pH, temperature, environment
19
Q
What is the Haldane effect?
A
Describes hemoglobin’s increased affinity for CO2 when deoxygenated
20
Q
What is the Heparin dose and goal ACT for SPB?
A
300-400 units/kg
About 480 seconds
21
Q
What lab test best measures actual Heparin concentration for CPB?
A
HiTT (High Dose Thrombin Time)
22
Q
What is the initial compensatory mechanism to maintain O2 delivery in the setting of anemia?
A
Rightward shift in the oxygen-hemoglobin dissociation curve
23
Q
Patient with recent history of postpartum hemorrhage now with inability to breastfeed. Likely (board answer) diagnosis?
A
Postpartum pituitary necrosis
24
Q
What is most common cause of death in women with preeclampsia?
A
Stroke
25
What finding can differentiate TRALI from other types of transfusion reactions?
Leukopenia
26
Which nerve block carries the highest risk of pneumothorax?
Supraclavicular
27
Key features of trisomy 21
```
Single palmar crease
Upslanting palpebral fissures
Endocardial cushion defects
Atlantoaxial instability
OSA
```
28
Key Features Trisomy 18
VSD
Rocker Bottom feet
Clenched hand with overriding digits
-Edwards syndrome
29
Key features trisomy 13
Holoprocencephaly
Cleft lip
Absent ribs
Polydactyly
_Patau syndrome
30
Key features trisomy 8
Long face
Wide nose
Thick lower lip
Cleft palate
31
What is the most common congenital heart defect recognized at birth?
VSD
32
Separation anxiety begins at what age?
6-8 months
33
Anesthesia specifics for CP:
- Roc dosing
- Succs
- MAC
- Coagulation
- Roc requirements are normal to increased
- Succs in not contraindicated
- MAC is decreased
- Coagulation factors abnormal
34
Open ureteral reimplantation, postop analgesia, what is mechanism of postop pain and preferred analgesia postop?
Bladder spasm
Caudal catheter
35
In kids what are 4 independent risk factors for PONV?
1. Age > 3
2. History is fam or patient
3. Surgery > 30 min
4. Strabismus surgery
36
What is preferred initial agent in treatment of cardiogenic shock?
Dobutamine
37
Brainstem ischemia is best monitored with what?
Brainstem auditory evoked potentials
38
What is the effect of isoflurane on the baroreceptor reflex?
Blunts the response
39
Why should hyperventilation be avoided in pregnancy?
Hypocarbia increases uterine vascular tone and decreases uterine perfussion
40
Radiation is related to distance how?
Inversely proportional to the square of the radius
41
What can decreased preload do to heart rate via what reflex?
"reverse" Bainbridge reflex. Reduced myocardial stretching results in decreased firing of SA node and bradycardia
42
Primary hyperparathyroidism does what to acid/base?
Non-ion gap metabolic acidosis
43
Wait how long after heparin for palacement of epidural?
4-6 hours
44
In decompensated heart failure what is the effect of diuretic?
Movement downward along the same frank-starling curve. This decreased the filling pressure and stretch on the myocardium
45
What are EKG findings of hypokalemia?
St-segment and T-wave depression
46
Dermatomes of lower extremity:
```
L1:
L2:
L3:
L4:
L5:
```
```
L1: Inguinal ligament
L2: Lateral thigh
L3: Medial (lower) thigh
L4: Medial lower leg and medial first toe
L5: Lower Lateral and lateral second toe
```
47
Describe the schematic of renin/angiotensin
Decrease in renal perfusion->renin secreted-> converts angiotensin (from liver) to angiotensin 1-> ACE (from lungs) converts to Angiotensin II -> Angiotensin II :
1. Increases sympathetic anctivity
2. Stimulates release of aldosterone
3. Arteriole vasoconstriction
4. Secretion of ADH which reabsorbs H20
Aldosterone: re-absorption of sodium, chloride, and H20. Potassium excreted
48
What is the equation for respiratory system compliance?
1/CRS= 1/CL + 1/CCW
```
CL= Compliance of lung
CW= Compliance of Chest Wall
```
49
Typical intracardiac pressures:
RA, RV, LA, LV
RA: 1-10
RV: 15-30/0-8
LA: 8-10
LV: 140/4-12
50
Transtracheal injection with anesthetize what nerve?
Recurrent laryngeal
51
What fracture is associated with radial nerve palsy?
Humerus shaft
52
In ESRD other than hyperkalemia what other electrolyte abnormality is common?
Hypocalcemia
53
According to AHA what is definition of hypertension and hypotension?
Hypertension = 130/80
| Hypotension is 90 mmHg or MAP 65
54
What is current preoperative recommendations regarding Metformin?
Continue untill Day of Surgery
55
In antiphospholipid syndrome what is elevated? What is not elevated?
PTT is elevated
PT is not elevated
56
What is minimum amount of wait time after MI in the case of no intervention?
60 days
57
Patient with symptomatic idiopathic intracranial hypertension presents in labor. What is best anesthetic?
Intrathecal catheter. This was medication can be administered with quick relief of pain (ICP increases with pain) and ability to remove CSF.
An epidural can increase the pressure and lead to ocular nerve injury
58
A simple facemask with flows of 5-10 L/min O2 delivers approximately what FiO2?
35-50%
59
An increase in albumin and phosphates will cause what acid/base abnormality? Why?
Metabolic acidosis. Albumin and phosphates are weak acids
60
Chronic phenytoin and gabapentin do what to NDNMB?
Resistance to blockade
61
What is dosing for intralipid in the setting of LAST?
20% lipid emulsion with bolus of 1.5ml/kg or 2-3 mins followed by infusion at .25 ml/kg/min
62
Which Mapleson circuit is most efficient user of fresh gas flow during spontaneous ventilation?
Mapleson A
63
How does Pregnancy affect speed of inhalation induction? Why?
Speeds it up 2/2 increased MV, decreased FRC, decreased MAC
64
Peritoneal dialysis may be preferred in what patient population?
Patients that cannot tolerate large hemodynamic shifts
65
Placing a magnet will change pacemaker to what mode?
To an asynchronous mode. So DDD to DOO, VVI to VOO, AAI to AOO, etc.
66
What are three asynchronous pacemaker modes?
AOO, VOO, DOO
67
What will ABG in patient with CO poisoning show?
Acid/Base, SpO2, SaO2
Metabolic acidosis
Normal PaO2
Falsely elevated SpO2 and calculated SaO2
68
Medial calf receives sensory innervation from what nerve?
Femoral nerve via the saphenous
69
Neonate with abdominal wall defect, hypoglycemia, large tongue. Diagnosis?
Beckwith-Wiedemann syndrome
70
Once daily dosing of prophylactic LMWH, how long to wait for placement of epidural?
12 hrs
71
What is the effect of anemia on coagulation cascade and clot formation?
Longer to initiate coagulation cascade, but stronger clot
72
What distinguishes OSA from CSA?
Snoring
73
Who needs stress dose steroids and what's the dose?
Patient on > 10mg/day Prednisone or those taking > 10mg/day but stopped < 3 months ago.
Dose is 25mg hydrocortisone
74
What lung parameter increases with administration of labor epidural?
Vital Capacity
75
Cardiogenic shock is defined by a PCWP above what value? CI below what?
18, 2.2
76
How to remember carotid sinus vs carotid body?
"Sinus pressure." "Body chemistry"
77
What is current recommendation for intraoperative fluid management in infants and children?
20-40 ml/kg throughout the case
78
What is the relationship of sux with histamine release and bronchospasm?
It does cause a histamine release, however it does not cause bronchospasm and is safe in asthmatics
79
What are two risk factors/characteristics of aspirate that cause aspiration pneumonitis?
Volume > 0.4 mL/kg
| pH < 2.5
80
What is the difference between a paired and unpaired T-test?
A paired T-test is for a single group, unpaired is for two.
81
Spinal for lateral wall bladder tumor. What additional nerve must be blocked to prevent kicking?
Obturator nuerve
82
What is different about living liver donation in adult to kid compared to adult to adult?
In adult to child the left liver can be donated
83
How do benzos affect the CO2 ventilatory respone curve?
Decreases the slope of the curve
84
Which side effect of neostigmine is not reversed by an anticholinesterase?
Paradoxical muscle weakness
85
Why is the NPO guideline for breast milk 4 hours but clear liquids is 2 hours?
Studies have shown that breast milk leads to larger gastric volumes
86
What is the primary process performed by the body to compensate for heart failure?
Diuresis and increased sympathetic activity
87
What happens to sputum production after cessation of smoking?
Increases
88
What is pneumonic for Mapleson A vs Mapleson D?
Mapleson A is better for SpontAneous ventilation, Mapleson D is better for controlleD
89
What is the alveolar gas equation?
PAO2 = FiO2* (Patm-PH20) - PaCO2/RER
```
Patm = 760
PH20 = 47
RER = 0.8
```
90
Infants who drink cow's milk prior to 12 months of age are at increased risk of what?
Iron deficiency anemia
91
Patient with COPD as administered excessive O2 with resultant hypercarbia. Why?
V/Q mismatch
92
What is the effect of barbituates on neuro physiology?
Decrease CBF, ICP, and CMRO2
93
On average how long does a Type and Screen take?
30-45 minutes
94
What number predicts turbulent flow and how is it calculated?
Reynold number = velocity * density * diameter / viscosity
When Reynolds number is high (>4000) turbulent flow occurs
95
In desflurane vaporizer if atmospheric pressure decreases by half what must be done to dial setting to achieve one MAC?
Must increase percentage.
96
What is the most common cause of respiratory failure in the pregnant patient?
ARDS
97
What coagulation factors decrease in pregnancy?
XI, XIII
98
What surgery is a risk factor for anterior ischemic optic neuropathy?
Posterior ischemic optic neuropathy?
Anterior: Cardiac
Posterior: Spine surgery
99
What does Nitrous Oxide do to CMO2, CBF, ICP?
Increases all three
100
What is a risk factors for bradycardia in sux administration?
Repeat dosing
101
What disease carries highest seroconversion risk 2/2 needle stick?
Hep B e antigen
102
What is the effect of epidural on uterine blood flow?
Increased if hypotension is avoided
103
Aminocaproic acid binds what?
Plasminogen
104
Describe P50 of hemoglobin affinity for O2 with age
Affinity is highest (lowest P50) in newborns. It is lowest (highest P50) at one year of age. It reaches adult levels at age 10.
So on the curve from left to right: newborn -> adult -> infant
105
What foods are generally associated with a latex allergy?
Fruit (and some nuts). Avocado
106
Which NMBD has an active metabolite that is nearly as potent as the original?
Vecuronium
107
GBS resembles what on pulmonary function tests?
Restrictive Lung Disease
108
What is the Bainbridge Reflex?
Tachycardia in response to increased CVP
109
In awake craniotomy if a seizure is caused by cortical stimulation what is first step in treatment (2 things)?
Ice and propofol
110
What is the strong ion difference?
SID = (Strong cations - Strong anions)
111
What morphine equivalent is recommended prior to considering starting a fentanyl patch?
45 mg/day
112
What is the EKG finding for hypocalcemia?
Prolonged QT
113
How are caudal blocks dosed in peds?
ml/kg. with 0.5-1.5 ml/kg depending on desired level
114
What are the three differences between aortic and peripheral artery waveforms?
In peripheral the systolic pressure is higher, diastolic is lower, and pulse pressure is wider
115
The intrinsic pathway includes what factors?
Extrinsic?
Intrinsic: I, II, V, VIII, IX, X, XI, XII
Extrinsic: I, II, V, VII, X
116
An oxygen tank is full at what PSI and that correlates with how many liters?
2000 PSI, 600 L
117
What is the equation for saturated vapor pressure used to calculate volume percentage in variable bypass vaporizer?
Agent SVP/Total pressure = Agent Vapor volume/(Carrier volume + agent vapor volume)
118
What is the mechanism of action of LMWH?
Binds AT-III with inhibits factor Xa and Thrombin (indirect inhibition). More specific to factor Xa than unfractioned heparin
119
How does rocuronium and neostigmine differ in children?
They are more potent in children compared to adults
120
What drug is administered in Beta Blocker overdose? Why?
Glucagon. It works to increase heart rate (and contractility) independent of adrenergic pathways. It works via cAMP.
121
Cyanide toxicity should be suspected when? What is first line treatment?
Suspected in fire involving synthetic material ("Tire factory"). Treatment: Hydoxocobalamin
122
Acute renal failure in a patient with cirrhosis and an inciting event?
Type 1 hepatorenal syndrome
123
How is pain improved in lumbar spinal stenosis?
Back flexion
124
What increases risk of citrate toxicity?
- FFP
- Peds
- Liver disease
- Hyperventilation (decreased Ca++)
- Hypothermia
125
In patient with ARDS and associated V/Q mismatch, what role does inhaled nictric oxide play?
Increases blood flow to only ventilated alveoli without reversing hypoxic pulmonary vasoconstriction
126
Spinal cord and dural sac end where in infants?
L3 and S3
127
Why is bradycardia less common in infants under spinal anesthesia?
Because they have high vagal tone and immature sympathetic system. Therefore the sympathectomy associated with spinal anesthesia isn't significant because children are not dependent on their cardiac accelerating fibers (T1-T4)
128
How is neo/glyco dosed in ESRD?
No change
129
Ticlopidine is an antithrombotic agent with what mechanism?
ADP receptor antagonist
130
What is the modified Bernoulli equation to calculate pressure gradients across valves?
Pressure gradient = 4*(peak velocity)^2
131
Explain what the flow volume loop looks like in mediastinal mass. Why?
A mediastinal mass causes a plateaued expiratory loop. This is because the mass is a variable intrathoracic lesion. In this scenario there is compression of the airway. During inspiration the negative pressure of inspiration inside the chest serves to stent open the airways. Expiration does the opposite and makes the obstruction worse.
132
What is the primary mechanism behind delayed hemolytic transfusion reaction?
Donor red cell antigens
These are antigens to which the recipient has previously been exposed
133
External compression on the eye can cause vision loss via what?
Central retina artery occlusion
134
The sacral hiatus is located at what level of the spine?
S4-S5
135
Treatment for stridor 2/2 subglottic stenosis?
Helium/Oxygen 70/30
136
How do you calculate myocardial oxygen consumption?
MVO2 = CBF (AO2-VO2)
137
What is the correlation between strong ion deficit and pH?
They follow each other. So a decrease in strong ion deficit corresponds with a decrease in pH
138
What is the mechanism of action of the following antiemetics?
1. Ondanseton
2. Metoclopramide
3. Droperidol
4. Scopolamine
1. 5-HT3 antag
2. Dopamine antagonist (notrecommended after Zofran)
3. Dopamine antagonist
4. Anticholinergic
139
Why are pregnant women at a higher risk for seizure?
Elevated estrogen levels
140
What are the three waves on a CVP?
A wave- Atrial systole
C-wave- Systole (ventricular Contraction)
V-wave- Atrial filling ("Villing")
141
What is an advantage of whole blood over pRBCs?
Greater percentage of viable RBCs
142
Which circuit is most efficient user of fresh gas flow during spontaneous ventilation?
Mapleson A.
SpontAneous
143
Loss of awareness and recall typically occurs at what MAC?
0.4-0.5
144
What is anesthetic concern in myotonia congenita? Can sux be used?
Severe masseter spasm.
Not associated with MH and sux can be used
145
What is drug of choice in suspected protamine reaction?
Epinephrine
146
What is treatment for botulism?
< 1 year -> Immune globulin
| > 1 yr -> Antitoxin
147
Medial calf is innervated by what? Branch of what?
Saphenous. Branch of Femoral
148
What is the basic type of cellular connection that allows for fast signal propagation in the cardiac myocyte?
Gap junctions
149
What are the 4 independent risk factors for PONV in children?
1. Age > 3
2. Family or personal history
3. Surgery > 30 min
4. Strabismus surgery
150
Volatile anesthetics works on what three receptors?
GABA
Sodium channels
Background Potassium Channels
151
Which NMBD has a metabolite that is nearly as potent as its parent drug?
Vecuronium
152
Central retinal artery occlusion is caused by what mechanism?
External eye compression
153
Opioid induced pruritus is due to activation of what? Treatment?
Activation of receptors in medulla and trigeminal nucleus. Treatment: Naloxone/Naltrexone
154
What two factors decrease during pregnancy?
XI, XIII
155
What is the most common cause of respiratory failure in the pregnant patient?
ARDS
156
What is the difference between complex regional pain syndrome type I and Type II
Type I is associated with minor injury, type II with major nerve injury
157
Equation for odds ratio
(a/b)/(c/d)
